Hao Song-Li, Zhang Chun-Lan, Meng Xiao-Yu
Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang Province, China.
Medicine (Baltimore). 2023 Oct 13;102(41):e35152. doi: 10.1097/MD.0000000000035152.
The optimal drug for treatment with polycystic ovary syndrome (PCOS) was in debate. We did this network meta-analysis to assess the efficacy and safety of different drugs for reducing testosterone levels in women with PCOS.
We searched studies from inception until January 10, 2023, through PubMed, Embase, and Cochrane Library database. All studies comparing different drugs for reducing testosterone levels in women with polycystic ovary syndrome were included in this network meta-analysis. Outcomes were total testosterone levels, free testosterone levels, and withdraw due to adverse events. We calculated the surface under the cumulative ranking curve (SUCRA) for each treatment.
Finally, a total of 13 studies were finally included in this network meta-analysis. In head-to-head comparison, atorvastatin (WMD -3.1, 95% CrI: -3.7 to -2.5), metformin (WMD -2.6, 95% CrI: -3.5 to -1.6), metformin + simvastatin (WMD -2.8, 95% CrI: -4.1 to -1.5), simvastatin (WMD -2.7, 95% CrI: -4.2 to -1.3), spironolactone (WMD -3.1, 95% CrI: -4.3 to -1.9), spironolactone + metformin (WMD -3.2, 95% CrI: -4.5 to -2.0) were all more effective than the placebo, and the difference was statistically significant (P < .05). The SUCRA shows that spironolactone + metformin ranked first (SUCRA, 85.0%), Atorvastatin ranked second (SUCRA, 77.7%), Spironolactone ranked third (SUCRA, 77.2%), and metformin + simvastatin ranked the fourth. The SUCRA of different drugs for free testosterone levels shows that atorvastatin ranked first (SUCRA, 75.0%), spironolactone + metformin ranked second (SUCRA, 5.3%), metformin + simvastain ranked third (SUCRA, 62.6%), and spironolactone ranked the fourth (SUCRA, 56.4%). No statistically significant differences were found between the 2 treatment groups for withdrawn due to adverse events (P > .05).
Considering the network meta-analysis and rankings, atorvastatin was recommended to be the optimal drug for treatment PCOS. However, the optimal dose of atorvastatin was unknown and should be verified by more randomized controlled trials.
多囊卵巢综合征（PCOS）治疗的最佳药物存在争议。我们进行了这项网状Meta分析，以评估不同药物降低PCOS女性睾酮水平的疗效和安全性。
我们通过PubMed、Embase和Cochrane图书馆数据库检索了从研究开始至2023年1月10日的研究。所有比较不同药物降低多囊卵巢综合征女性睾酮水平的研究均纳入本网状Meta分析。结局指标为总睾酮水平、游离睾酮水平以及因不良事件退出研究。我们计算了每种治疗的累积排名曲线下面积（SUCRA）。
最终，共有13项研究纳入本网状Meta分析。在直接比较中，阿托伐他汀（加权均数差 -3.1，95%可信区间：-3.7至-2.5）、二甲双胍（加权均数差 -2.6，95%可信区间：-3.5至-1.6）、二甲双胍 + 辛伐他汀（加权均数差 -2.8，95%可信区间：-4.1至-1.5）、辛伐他汀（加权均数差 -2.7，95%可信区间：-4.2至-1.3）、螺内酯（加权均数差 -3.1，95%可信区间：-4.3至-1.9）、螺内酯 + 二甲双胍（加权均数差 -3.2，95%可信区间：-4.5至-2.0）均比安慰剂更有效，差异有统计学意义（P < 0.05）。SUCRA显示，螺内酯 + 二甲双胍排名第一（SUCRA为85.0%），阿托伐他汀排名第二（SUCRA为77.7%），螺内酯排名第三（SUCRA为77.2%）；二甲双胍 + 辛伐他汀排名第四。不同药物降低游离睾酮水平的SUCRA显示，阿托伐他汀排名第一（SUCRA为75.0%），螺内酯 + 二甲双胍排名第二（SUCRA为5.3%），二甲双胍 + 辛伐他汀排名第三（SUCRA为62.6%），螺内酯排名第四（SUCRA为56.4%）。两组因不良事件退出研究的差异无统计学意义（P > 0.05）。
综合网状Meta分析及排名，推荐阿托伐他汀为治疗PCOS的最佳药物。然而，阿托伐他汀的最佳剂量未知，应通过更多随机对照试验进行验证。
